The Heart of Addiction

How psychology drives addictive behavior.

If you do something too much, is it an addiction?

Diagnosing addiction can be tricky

This week millions of families will gather together to celebrate a holiday, Easter or Passover. At some of these gatherings an uncle or cousin will talk too loud, interrupt too much or turn an innocent conversation about the state of the local baseball team into an ugly argument. He or she has had too much to drink. Do these people have alcoholism?

Of course, first you'd want to know if this was the only time they'd done this. Anyone can overdo behavior - drink, gamble, eat - without having an addiction. But what if this had happened before? How easy is it to make a diagnosis?

Actually, this may not be easy. Sometimes people overdo in certain situations, but the rest of their lives they're fine. Large family gatherings may be just that difficult kind of setting. It can produce the feeling, "Hey, it's just family! What a great time to toss out good sense, or even good manners!"

The setting you are in does affect self-control. This phenomenon is well-known to the gambling industry, for instance. If you've ever been in a casino you know that they have no windows and no clocks. The setting is designed to help you ignore the fact that time is passing. And the room is supplied with bright lights and exciting sounds, showing that somewhere somebody is winning a fortune. You are primed to feel that it's all fun here, a place to be carefree. And you don't have to worry about losing money because the casino has no money! There are just these colorful chips. How different they are from the hard-earned cash I worry about in my regular life. Finally, if this isn't enough to help ease your mind out of its normal routine, the casinos provide one other incentive. They give out free liquor.

So, setting can influence behavior. Therefore, if repetitive, excessive behavior is restricted to specific settings, it may not be an addiction at all. A famous example is the Vietnam soldiers I've described in earlier blogs, who used heroin because they were in a war zone but stopped when they returned home.

There are other non-addiction causes of excessive behavior. Habits are a good example. Habits are just automatic behaviors you perform without having to think about them. They can be stopped when you decide to pay attention to them because, unlike addictions, they have no deeper emotional basis. For example, one woman said, "I always had a candy bar after lunch. I figured it would add a pound or two but my weight is okay and it was just something I always did. Then my doctor told me I was pre-diabetic and had to watch my sugar intake. What a bummer. But I have a lot of willpower and let me tell you, that was the end of the candy bars." The key difference between habits and addictions is that habits, having no deeper emotional function, can be broken with willpower alone. Addictions, of course, cannot. But they can be easily confused unless you figure out what is driving the behavior.

Repetitive, excessive behavior can also be the result of trying to go along with the group. If "everybody is doing it" then you may do it too, against your better judgment. This is common among adolescents, where acceptance by the "in" group may feel critical. But adults respond to interpersonal pressure too, especially if it is a loved one who is encouraging you to drink or take drugs with him, or her.

If a behavior can be repetitive and excessive without being an addiction, how do you diagnose true addictions? Certainly, it's not enough that the behavior is destructive, since lots of repetitive non-addictive behaviors are destructive. Drinking and driving even without having alcoholism can still kill you. And to confuse matters, even though addictions always cause trouble for the people who suffer with them, the trouble may be small enough to go unnoticed for some time. A man who had millions compulsively gambled on the lottery, but never lost enough to make much difference in his life, at least financially.

If you can't reliably diagnose addictions from their outwardly observable effects, then it is clear that they have to be diagnosed from the inside out. Addictions are emotional mechanisms to manage overwhelmingly helpless feelings, as I've described in my books and this blog. If you want to diagnose addiction in yourself or others, you have to know the reasons for performing the behavior. Repetitive, excessive behaviors that are driven by an urgent need to reverse an overwhelming sense of helplessness are addictions. Addictions don't depend on the setting or a need to keep up with the group, and they're not habits that can be broken by willpower alone.

When the usually peaceful Uncle Max turns a discussion of the home team's pitching staff into an angry argument, he's had too much to drink. But we'd want to get to know him better, and maybe discreetly suggest to him that he give some thought to this himself, before settling on the conclusion that he has alcoholism. It's a big mistake to tell people that they have an addiction if they really don't. That's a quick way to stop being listened to. But it's a big mistake to fail to diagnose it, too. The best course of action is to learn more about the nature of addiction and learn more about the person (or yourself) that you are concerned about.

For more about diagnosing addiction and non-addiction causes of excessive behaviors, see my books, "Breaking Addiction: A 7-Step Handbook for Ending Any Addiction" and my earlier book, "The Heart of Addiction," both published by HarperCollins.

 

Lance Dodes, M.D., is an assistant clinical professor of psychiatry at Harvard Medical School.

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